Prevention of deep infection in joint replacement surgery

Jämsen, Esa; Furnes, Ove; Engesæter, Lars B.; Konttinen, Yrjö T.; Odgaard, Anders; Stefánsdóttir, Anna; Lidgren, Lars

doi:10.3109/17453674.2010.537805

Cited by 84 publications

(78 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We validated these findings in our study for hip arthroplasties in patients with BMI C 40 kg/m 2 (OR, 3.86; 95% CI, 1.67-8.86; p \ 0.001). We also found that patients with BMI C 40 kg/m 2 and active tobacco use, patients colonized with S aureus and Jämsen et al [11]active tobacco use, revision patients with active tobacco use, revision patients colonized with S aureus with active tobacco use, and patients colonized with S aureus, BMI C 30 kg/m 2 , and active tobacco use had three to 12 times greater risks of infection as a result of the additive effects of tobacco use (Table 3). It is therefore important for patients and surgeons to quantify the magnitude of risks and combination of risk factors.…”

Section: Pseudomonas Aeruginosamentioning

confidence: 66%

“…They included rheumatologic disease, obesity, coagulopathy, and preoperative anemia. Jämsen et al [11] also identified similar patient-related risk factors in addition to high ASA score, diabetes, urinary disorders, malnutrition, and tobacco use as significant contributors to postoperative infections. Pulido et al [20] instituted a preoperative protocol designed to minimize risk factors for infection.…”

Section: Pseudomonas Aeruginosamentioning

confidence: 98%

“…It is therefore important for patients and surgeons to quantify the magnitude of risks and combination of risk factors. Because tobacco use was also found to be a significant modifiable risk factor in previous studies [11,16], it is worthwhile to optimize patients before surgery to decrease the chance of infection.…”

Section: Pseudomonas Aeruginosamentioning

confidence: 99%

See 2 more Smart Citations

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

Maoz

Phillips

Bosco

et al. 2015

Clinical Orthopaedics &Amp; Related Research

158

View full text Add to dashboard Cite

Background Periprosthetic joint infections (PJIs) are associated with increased morbidity and cost. It would be important to identify any modifiable patient-and surgicalrelated factors that could be modified before surgery to decrease the risk of PJI. Questions/purposes We sought to identify and quantify the magnitude of modifiable risk factors for deep PJIs after primary hip arthroplasty. Methods A series of 3672 primary and 406 revision hip arthroplasties performed at a single specialty hospital over a 3-year period were reviewed. All deep PJIs were identified using the Centers for Disease Control and Prevention case definitions (ie, occurs within 30-90 days postoperatively, involves deep soft tissues of the incision, purulent drainage, dehiscence and fever, localized pain or tenderness). Univariate and multivariate analyses determined the association between patient and surgical risk factors and PJIs. For the elective patients, the procedure was performed on the day of admission (''same-day procedure''), whereas for the fracture and nonelective patients, the procedure was performed 1 or more days postadmission (''nonsame-day procedure''). Staphylococcus aureus colonization, tobacco use, and body mass index (BMI) were defined as patient-related modifiable risk factors. Results Forty-seven (1.3%) deep PJIs were identified. Infection developed in 20 of 363 hips of nonsame-day procedures and 27 of 3309 same-day procedures (p = 0.006). There were eight (2%) infections in the revision group. After controlling for confounding variables, our multivariate analysis showed that BMI 3 40 kg/m 2 (odds ratio [OR], 4.13; 95% confidence interval [CI], 1.3-12.88; p = 0.01), operating time [ 115 minutes (OR, 3.38; 95% CI, 1.23-9.28; p = 0.018), nonsame-day surgery (OR, 4.16; 95% CI, 1.44-12.02; p = 0.008), and revision surgery (OR, 4.23; 95% CI, 1.67-10.72; p \ 0.001) are significant risk factors for PJIs. Tobacco use and S aureus colonization were additive risk factors when combined with other significant risk factors (OR, 12.76; 95% CI,; p = 0.017). Conclusions Nonsame-day hip and revision arthroplasties have higher infection rates than same-day primary surgeries. These characteristics are not modifiable and should be categorized as a separate cohort for complication-reporting purposes. Potentially modifiable risk factors in our patient population include operating time, elevated BMI, tobacco use, and S aureus colonization. Modifying risk factors may

show abstract

Section: Pseudomonas Aeruginosamentioning

confidence: 66%

Section: Pseudomonas Aeruginosamentioning

confidence: 98%

See 1 more Smart Citation

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

Maoz

Phillips

Bosco

et al. 2015

Clinical Orthopaedics &Amp; Related Research

158

View full text Add to dashboard Cite

show abstract

“…In 2000, the Institute of Medicine reported that the performance of today's healthcare system is far inferior than it could and should be and encouraged healthcare organisations "to develop a culture of safety and create systems for continuously monitoring patient safety" [14]. In a recent review of preventing deep infection in joint replacement surgery, Jamsen et al [16] reported that monitoring infection rates on a local, national and even international scale is an essential part of quality control and is necessary in order to be able to identify weaknesses in infection prevention practices. However, to date, to the best of our knowledge, no such monitoring system has been described in orthopaedic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, strategies for preventing infections have received considerable attention from the orthopaedic community. Numerous measures at various steps of the process of care have been implemented, including pre-operative optimisation of the patient's condition, improved peri-operative management to decrease the risk of contamination and routine prophylactic antibiotic therapy [16].…”

Section: Introductionmentioning

confidence: 99%

Monitoring the one year postoperative infection rate after primary total hip replacement

Biau

Leclerc

Marmor

et al. 2011

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Infection of a total hip replacement is potentially a devastating complication. Statistical process control methods have been generating interest as a means of improving the quality of healthcare, and we report our experience with the implementation of such a method to monitor the one year infection rate after primary total hip replacement. Method Infection was defined as the growth of the same organism in cultures of at least two aspirates or intra-operative specimens, or growth of one pathogen in a patient with local signs of infection such as erythema, abscess or draining sinus tract. The cumulative summation test (CUSUM test) was used to continuously monitor the one year postoperative infection rate. The target performance was 0.5% and the test was set to detect twice that rate. Results Over the three year study period, 2006 primary total hip replacements were performed. Infection developed within one year after surgery in eight (0.4%) hips. The CUSUM test generated no alarms during the study period, indicating that there was no evidence that the process was out of control. ConclusionThe one year infection rate after primary total hip replacement was in control. The CUSUM test is a useful method to continuously ensure that performance is maintained at an adequate level.

show abstract

Antibiotic‐eluting orthopedic device to prevent early implant associated infections: Efficacy, biocompatibility and biodistribution studies in an ovine model

et al. 2017

View full text Add to dashboard Cite

Infection of orthopedic devices is a major complication in the postsurgical period generating important health issues and economic consequences. Prevention strategies could be based on local release of antibiotics from the orthopedic device itself to avoid adhesion and growth of bacteria. The purpose of this work is to demonstrate the efficiency to prevent these infections by a cefazolin-eluting, perforated stainless steel implant in an in vivo ovine model. The device was placed in the tibia of sheep, one group receiving cefazolin-loaded implants whereas the control group received empty implants. All implants were experimentally infected by direct inoculation of Staphylococcus aureus ATCC 6538. In vitro cytotoxicological studies were also performed to check the effect of antibiotic on cell viability, integrity, and cycle. Results showed that sheep receiving cefazolin-loaded devices were able to avoid implant-associated infections, with normal tissue healing process. The antibiotic release followed a local concentric pattern as demonstrated by high-performance liquid chromatography detection in tissues. The in vitro results indicate the lack of relevant cytotoxic effects for the maximum antibiotic concentration released by the device. These results demonstrate the efficiency and safety of cefazolin-eluting implants in an ovine model to prevent early postsurgical infections of orthopedic devices. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1976-1986, 2018.

show abstract

Prevention of deep infection in joint replacement surgery

Cited by 84 publications

References 66 publications

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

Monitoring the one year postoperative infection rate after primary total hip replacement

Antibiotic‐eluting orthopedic device to prevent early implant associated infections: Efficacy, biocompatibility and biodistribution studies in an ovine model

Contact Info

Product

Resources

About